Excessive Scarring Research Articles

Insight about Different Physical Therapy Techniques for Management of Hypertrophic Scars

The most common complication of burn injuries is scar formation, which causes structural and cosmetic impairment. Between 1 and 3 months after an injury, hypertrophic scarring develops. Hypertrophic scarring caused by surgical operations, trauma, and particularly burns is a source of worry for patients and a difficult problem for practitioners. Burn scars can cause aesthetic and functional problems, resulting in limitations in activities of daily living. They can substantially impact one's quality of life, both functionally and cosmetically. Despite using many therapeutic techniques, scar control remains a significant concern. Pharmacological and physical therapy, as well as surgical procedures, are used with varying degrees of success and efficacy. New treatments for scar prevention are currently making their way into normal practice, due to the implementation of novel procedures for treating hypertrophic scars and keloids, as are new insights into the pathophysiology of excessive scarring. The purpose of this study was to review different physical therapy modalities that might be effective for the management of hypertrophic scars.

Preferences of different breast reduction techniques: Survey of board-certified plastic surgeons.

Breast reduction is a common and safe procedure with predicted cosmetic outcomes. Many techniques have evolved over the recent decades. The aim of this study is to determine what type of breast reduction techniques are currently preferred among board certificated Saudi plastic surgeons and assess the surgeons' satisfaction, surgeon-reported patient satisfaction, and complication rates post breast reduction with the preferred techniques. This is a cross-sectional questionnaire-based study. The questionnaire was adapted from previously published studies and distributed to a small group before full-scale distribution to Saudi plastic surgeons by email and communication groups. The mean age of the participants was 45.4 (± 8.9). Most participants were males (82%), and the majority held a Saudi board (44%), and 20% held a Canadian board. Significant differences between different board certifications, held fellowship, and years of experience emerged in terms of surgical preferences. The two most common complications reported by surgeons were suture splitting (34%) and excess scarring (24%). In Saudi Arabia, inverted T resection patterns with superior or superomedial pedicle designs are the standard techniques used in breast reduction, with higher satisfaction rates and fewer complications. Surgical preferences were significantly different between surgeons based on their training and held fellowships.

Drainage glaucoma surgery

Glaucoma is a chronic disease characterized by optical neuropathy, progressive degeneration of retinal ganglion cells and nerve fiber layer, and is the leading cause of irreversible blindness in the world. Currently, the most reliable way to achieve stable normalization of intraocular pressure is surgical treatment, and its success is measured by the duration of the hypotensive effect. However, surgical interventions do not always have a prolonged effect. One of the most drastic and effective ways of treating patients with glaucoma is surgery involving installation of a drainage implant. The use of implants in the area of surgical intervention is the most effective way to preserve the outflow routes of intraocular fluid created during antiglaucoma interventions. The use of implants is aimed at reducing excessive scarring in the filtration zone and at creating ways of resorption of intraocular fluid. In the history of glaucoma surgery, numerous designs for drainage implants have been proposed, differing from each other in material, drainage structure, implantation technique, and results. This literature review describes the types of anti-glaucoma drainage devices and their latest modifications, and presents the statistics of postoperative complications and long-term results of the use of foreign- and Russian-made implants in the treatment of glaucoma.

Controlling Inflammation Pre-Emptively or at the Time of Cutaneous Injury Optimises Outcome of Skin Scarring.

Inflammation plays an active role during the wound healing process. There is a direct association between the extent of injury as well as inflammation and the amount of subsequent cutaneous scarring. Evidence to date demonstrates that high levels of inflammation are associated with excessive dermal scarring and formation of abnormal pathological scars such as keloids and hypertrophic scars. In view of the multiple important cell types being involved in the inflammatory process and their influence on the extent of scar formation, many scar therapies should aim to target these cells in order to control inflammation and by association help improve scar outcome. However, most current treatment strategies for the management of a newly formed skin scar often adopt a watch-and-wait approach prior to commencing targeted anti-inflammatory therapy. Moreover, most of these therapies have been evaluated in the remodelling phase of wound healing and the evaluation of anti-inflammatory treatments at earlier stages of healing have not been fully explored and remain limited. Taken together, in order to minimise the risk of developing a poor scar outcome, it is clear that adopting an early intervention prior to skin injury would be optimal, however, the concept of pre-emptively priming the skin prior to injury has not yet been thoroughly evaluated. Therefore, the aim of this review was to evaluate the available literature regarding scar therapies that aim to target inflammation which are commenced prior to when a scar is formed or immediately after injury, with a particular focus on the role of pre-emptive priming of skin prior to injury in order to control inflammation for the prevention of poor scarring outcome.

Fluoxetine Ecofriendly Nanoemulsion Enhances Wound Healing in Diabetic Rats: In Vivo Efficacy Assessment.

Impaired diabetic wound healing is a major concern for health care professionals worldwide, imposing an intense financial burden and reducing the quality of life of patients. A dysregulation of this process can be responsible for the development of intractable ulcers and the formation of excessive scars. Therefore, the identification of novel pharmacological strategies able to promote wound healing and restore the mechanical integrity of injured tissue becomes essential. In the present study, fluoxetine ecofriendly nanoemulsion (FLX-EFNE) was prepared and its potential efficacy in enhancing wound healing was tested in diabetic rats. The Box–Behnken response surface design was used to select the optimized formulation that was prepared by the high-shear homogenization-based technique. A Zetasizer was used for the characterization of the optimized formulation, providing a FLX-EFNE with a globule size of 199 nm. For the in vivo study, a wound was induced by surgical methods, and diabetic rats (streptozotocin-induced) were divided into five groups: untreated control, vehicle-treated, FLX, FLX-EFNE, and positive control receiving a commercially available formula. The treatment continued from the day of wound induction to day 21. Then, the animals were sacrificed and skin tissues were collected at the site of wounding and used for biochemical, histopathological, immunohistochemical, and mRNA expression assessments. In the FLX-EFNE treated group, the rate of wound contraction and signs of healing were significantly higher compared to all other groups. In addition, angiogenesis, proliferation, and collagen deposition were enhanced, while oxidative stress and inflammation decreased. The present data highlight the enhanced wound healing activity of the optimized FLX-EFNE formulation.

An additional port in difficult laparoscopic cholecystectomy for surgical safety.

Tokyo Guidelines 2018, clinical practice guidelines for acute cholangitis and cholecystitis, recommend bailout procedures to prevent bile duct injury (BDI) during laparoscopic cholecystectomy (LC) for difficult gallbladder. We first insert an additional port (AP) for difficult gallbladder that may require bailout procedures. Because the usefulness of an AP during LC is unclear, we therefore examined the efficacy of the AP during LC in this study. Data were collected from 115 patients who underwent LC for acute cholecystitis in our department. The indications for AP were excessive bleeding, scarring, and poor visual field around Calot's triangle. AP was inserted into the right middle abdomen so as not to interfere with other trocars and was used by the assistant. Surgical outcomes were evaluated based on AP use during LC. AP was inserted in 19 patients during LC (AP group). The indications for AP were excessive bleeding in nine patients, scarring around Calot's triangle in seven patients, and poor visual field around Calot's triangle in three patients. Open conversion was performed in two patients in the non-AP group. BDI occurred in one patient in the non-AP group. In patients with Difficulty Score 3, operation time was significantly shorter (P=.038) and Critical View of Safety (CVS) score was significantly higher in the AP group (P=.046). AP is useful in patients with excessive bleeding to shorten operation time and increase the CVS score. AP may be one useful option for difficult gallbladder.

The matricellular protein decorin delivered intradermally with coacervate improves wound resolution in the CXCR3-deficient mouse model of hypertrophic scarring.

Cutaneous wound healing is an intricate orchestration of three overlapping phases of repair that encompass numerous cell types, signalling cascades, and microenvironment modifications to reach a successful resolution. Disruption of any of these steps will create an abnormal healing response resulting in either ulceration or excessive scarring. It has become evident that the extracellular matrix and its associated components are key orchestrators during this process. One of these essential matrix proteins is decorin, a small leucine-rich proteoglycan (SLRP) that acts as a regulator of collagen fibrillogenesis and a non-competitive inhibitor of multiple growth factors signalling cascades. Decorin is a necessary shut-off switch for the pro-reparative mechanism of the tissue replacement phase and limits the occurrence of hypertrophic scarring by preventing excessive repair. We investigated the use of decorin as a therapeutic by administering the matrix protein anchored in a slow-release coacervate in a hypertrophic scarring mouse model. The results show that early wound healing phase measurements exhibit little difference in performance compared to our coacervate-only baseline or HB-EGF-treated control mice. However, during the resolution phase of wound healing, the decorin-treatment significantly reduces cutaneous thickness, enhances collagen alignment, and improves overall wound scoring in the mice. Thus, mice treated with decorin display better healing outcomes and could limit the hypertrophic scarring phenotype in the coacervate only, and HB-EGF controls. These results suggest that decorin may be a promising tool and alternative therapy for patients who suffer from over-exuberant matrix deposition during wound healing.

Clinical features and the outcomes evaluation of hypertrophic scar treatment with triamcinolone injection at Can Tho University of Medicine and Pharmacy Hospital

Background: Excessive scarring has both cosmetic and psychological repercussions. Intra- scar injection, for example, makes a significant contribution to enhancing treatment efficiency.
 Objectives: To describe the morphological features, categorize, and assessing the effects of Triamcinolone injection therapy of hypertrophic scars. Materials and methods: A cross-sectional descriptive study of 80 patients with hypertrophic scars treated with triamcinolone intralesional injection at Can Tho University of Medicine and Pharmacy Hospital from 5/2018 to 5/2021. Results: There were 80 patients in all, with a male/female ratio of 1/1.05 and a median age of 15-35. There were 129 scars in all, with scar age >1 year accounting for 83%, keloid scars accounting for 64%, and hypertrophic scars accounting for the remaining 36 percent. Scars are most commonly seen on the trunk, accounting for 53.5 percent of all scars, particularly on the anterior chest wall. When the source of scars was discovered, trauma and acne accounted for 24% and 23%, respectively, while the rest were predominantly spontaneous scars, accounting for 49%. Scarring and discomfort of mild to moderate severity were common clinical symptoms; scars larger than 5cm in size had more symptoms than scars smaller than 5cm. Prior to the therapy, the mean Vancouver Score Scale-VSS was 6.55±2.13. After 24 weeks of the therapy, 96.7% of patients had entirely improved itching symptoms, 75% had completely improved pain, and 25% still had minimal pain. After therapy, the mean Vancouver Score Scale-VSS was 2.55±1.81 (p<0.05). At week 24, 3.75% of patients experienced skin shrinkage, 3.75% experienced depigmentation, and 13.75% experienced vasodilation. Conclusion: Triamcinolone intralesional injection should be utilized as a first-line therapy for hypertrophic scarring.

Morphological features of complicated gastroduodenal ulcers

The objective of the study was to evaluate structural changes in the margin of gastroduodenal ulcers complicated by perforation, bleeding or penetration in terms of the features of ulcer healing.Methods and materials. Histological and IHC studies were performed on 25 patients of the main group with perforated gastroduodenal ulcers and 23 patients of the control group with chronic recurrent ulcers complicated by bleeding and penetration. Histological sections were stained with hematoxylin and eosin, and Van Gieson's picrofuchsin. Immunohistochemical reactions were performed with antibodies to Ki-67, CD68, CD138, and CD34.Results. On macroscopic evaluation, a clear even margin of the perforation was noted. Histological examination with the background of acute dyscirculatory changes clearly shows a zone of necrosis and a weakly expressed layer of granulation tissue, which in majority of the cases was practically absent. The margin of a perforated ulcer consists of a minimally presented, clearly delimited zone of tissue detritus and a practically unchanged muscle layer. Plasma cells dominated in the cell infiltrate, and the index of proliferative activity in the epithelium of the ulcer margins was about 45 %, distributed fairly evenly.Conclusions. Perforated ulcers can be considered as a special group of ulcers with the most pronounced changes of infiltration by plasmatic cells and eosinophils, edema and acute dyscirculatory changes, uniform and fairly high proliferative activity of the epithelium. Changes in the margins of the perforated ulcer allow for complete regeneration without excessive scarring with precise suturing of the perforation.

Impulse Noise Removal Using Soft-computing

Image restoration has become a powerful domain now a days. In numerous real life applications Image restoration is important field because where image quality matters it existed like astronomical imaging, defense application, medical imaging and security systems. In real life applications normally image quality disturbed due to image acquisition problems like satellite system images cannot get statically as source and object both moving so noise occurring. Image restoration process involves to deal with that corrupted image. Degradation model used to train filtering techniques for both detection and removal of noise phase. This degeneration is usually the result of excess scar or noise. Standard impulse noise injection techniques are used for standard images. Early noise removal techniques perform better for simple kind of noise but have some deficiencies somewhere in sense of detection or removal process, so our focus is on soft computing techniques non classic algorithmic approach and using (ANN) artificial neural networks. These Fuzzy rules-based techniques performs better than traditional filtering techniques in sense of edge preservation.

Efficacy Of Microporous Tape In The Prevention Of Abnormal Post-Surgical Scars Among A Black Population.

A scar can be defined as a mark or a blemish resulting from a healed wound. All surgical incisions give rise to scars and approximately 15% have excessive scars. Some scars are thin lines which are almost unnoticeable, whereas others become abnormal when the amount of fibrosis is excessive or suboptimal or when it causes functional disability or aesthetic distress to the patient. The conversion of normal scarring to hypertrophic scarring occurs six to eight weeks after surgery as a result of increasing scar tension. Thus, scar support especially with the use of microporous tape is critical during this period. Objectives were to determine the efficacy of microporous tape in the prevention of abnormal post-surgical scars. A randomized control study which compared the limb scar outcome between post-surgical patients who underwent scar taping with microporous tape and those who did not. The scars were assessed at six weeks, three months and six months after surgery using the Patient and Observer Scar Assessment Scale. The test group had microporous tape applied to their scars over a period of six months and worn twenty-four hours daily. The tapes were changed every fortnight or whenever they fell off. The data was analyzed using SPSS-22. The categorical variables, the relative scar height, the scar width and the OSAS score were compared using the Chi-square test and the independent t-test respectively. At six weeks, 48.8% of non-taped scars and 97.6% of taped scars were normal; at three months 75.6% of non-taped scars and 2.4% of taped scars were abnormal while at 6 months 80.5% of non-taped scars and none of the taped scars were abnormal. Microporous tape is an effective modality for preventing abnormal scarring in postsurgical patients.

Beyond the Code: Noncoding RNAs in Skin Wound Healing.

An increasing number of noncoding RNAs (ncRNAs) have been found to regulate gene expression and protein functions, playing important roles in diverse biological processes and diseases. Their crucial functions have been reported in almost every cell type and all stages of skin wound healing. Evidence of their pathogenetic roles in common wound complications, such as chronic nonhealing wounds and excessive scarring, is also accumulating. Given their unique expression and functional properties, ncRNAs are promising therapeutic and diagnostic entities. In this review, we discuss current knowledge about the functional roles of noncoding elements, such as microRNAs, long ncRNAs, and circular RNAs, in skin wound healing, focusing on in vivo evidence from studies of human wound samples and animal wound models. Finally, we provide a perspective on the outlook of ncRNA-based therapeutics in wound care.

Contracting scars from fibrin drops.

This paper describes a microscale fibroplasia and contraction model that is based on fibrin-embedded lung fibroblasts and provides a convenient visual readout of fibrosis. Cell-laden fibrin microgel drops are formed by aqueous two-phase microprinting. The cells deposit extracellular matrix (ECM) molecules such as collagen while fibrin is gradually degraded. Ultimately, the cells contract the collagen-rich matrix to form a compact cell-ECM spheroid. The size of the spheroid provides the visual readout of the extent of fibroplasia. Stimulation of this wound-healing model with the profibrotic cytokine TGF-β1 leads to an excessive scar formation response that manifests as increased collagen production and larger cell-ECM spheroids. Addition of drugs also shifted the scarring profile: the FDA-approved fibrosis drugs (nintedanib and pirfenidone) and a PAI-1 inhibitor (TM5275) significantly reduced cell-ECM spheroid size. Not only is the assay useful for evaluation of antifibrotic drug effects, it is relatively sensitive; one of the few in vitro fibroplasia assays that can detect pirfenidone effects at submillimolar concentrations. Although this paper focuses on lung fibrosis, the approach opens opportunities for studying a broad range of fibrotic diseases and for evaluating antifibrotic therapeutics.

The Role of Survivin and Transcription Factor FOXP1 in Scarring After Glaucoma Surgery.

PurposeThis study aims to elucidate the role and mechanism of survivin and FOXP1 in scarring after glaucoma surgery and to evaluate the prevention and treatment of excessive wound healing and scar formation in an in vitro model of glaucoma filtration surgery.MethodsHuman Tenon's capsule fibroblasts (HTFs) were used with TGF-β to establish an in vitro cell model after glaucoma, observe survivin expression in the cell model, and observe HTFs proliferation after treatment with survivin inhibitor YM155 and the expression of α-SMA and collagen type I. In addition, the effects of survivin and cell proliferation in HTFs after knockdown of FOXP1 were observed by Western blot analysis.ResultsSurvivin was upregulated in HTFs after glaucoma surgery, and it could promote the cell proliferation of HTFs. After treatment with its inhibitor YM155, the cell proliferation of HTFs was inhibited, and the expression of α-SMA and collagen type I were decreased. The results showed that in knockdown of FOXP1, the expression of survivin was downregulated, and the cell proliferation of HTFs was significantly reduced.ConclusionsThis study demonstrates that targeting survivin with an inhibitory YM155 reduced fibrosis and the extracellular matrix (ECM), and it was regulated by the FOXP1 transcription factor. These results suggest that survivin could be a potential target for treating scar formation after glaucoma surgery.Translational RelevanceTogether with the results from previous survivin and FOXP1 preclinical studies, these data support the evaluation of this gene therapy candidate in clinical trials as a potential durable treatment for antiscarring of glaucoma surgery.

Cost and clinical effectiveness of aggressive surgical debridement and delayed primary closure of infected cardiac surgical wounds.

Postoperative wound infection in cardiac surgery remains a subject of significant concern due to associated morbidity, prolonged hospital stay and rise in treatment cost. A conservative management approach to postoperative wound infection with topical dressings and healing by secondary intention is not cost-effective and cosmetic results are less acceptable. We developed our institutional protocol for the treatment of infected postoperative cardiac surgical wounds to reduce hospital stay and improve cosmetic outcome. This study aims to compare our institutional protocol with the conservative management approach. Adult patients with postoperative superficial or deep sternal and/or leg wound infection were divided into two equal-sized groups and data collected from medical records. Group A was treated according to our institutional protocol of aggressive surgical debridement and delayed primary closure. Group B was treated according to conservative management with topical antiseptic wound dressings and healing by secondary intention. Data were analysed in retrospect with comparative statistics. A total of 30 patients took part in the study. Group A (n=15, seven male, eight female) had a mean age of 55.34±12.84 years. Group B (n=15, eight male, seven female) had a mean age of 56.46±10.21 years. Mean length of hospital stay in Group A and Group B was 5.13±2.06 and 36.67±22.28 days, respectively (p<0.0001). Calculated mean hospital costs were 16,271.61±6815.50 Saudi Riyals (approximately equivalent to $4330±700 USD) in Group A and 116,212.2±26,311 Saudi Riyals (approximately equivalent to $30,932±1813 USD) in Group B (p<0.05). Patients in Group A had linear scars comparable with primary postoperative wound scars, whereas patients in Group B had excessive non-linear scarring. In this study, cost and clinical effectiveness of aggressive surgical debridement and delayed primary closure was superior to conservative management with topical antiseptic wound dressings and healing by secondary intention in terms of a shorter hospital stay and better cosmetic outcome.

Hif-1a suppresses ROS-induced proliferation of cardiac fibroblasts following myocardial infarction.

We report that cardiac fibroblasts (CFs) and mesenchymal progenitors are more hypoxic than other cardiac interstitial populations, express more hypoxia-inducible factor 1α (HIF-1α), and exhibit increased glycolytic metabolism. CF-specific deletion of Hif-1a resulted in decreased HIF-1 target gene expression and increased mesenchymal progenitors in uninjured hearts and increased CF activation without proliferation following sham injury, as demonstrated using single-cell RNA sequencing (scRNA-seq). After myocardial infarction (MI), however, there was ∼50% increased CF proliferation and excessive scarring and contractile dysfunction, a scenario replicated in 3D engineered cardiac microtissues. CF proliferation was associated with higher reactive oxygen species (ROS) as occurred also in wild-type mice treated with the mitochondrial ROS generator MitoParaquat (MitoPQ). The mitochondrial-targeted antioxidant MitoTEMPO rescued Hif-1a mutant phenotypes. Thus, HIF-1α in CFs provides a critical braking mechanism against excessive post-ischemic CF activation and proliferation through regulation of mitochondrial ROS. CFs are potential cellular targets for designer antioxidant therapies in cardiovascular disease.

Speech and swallowing function following microsurgical reconstruction of palatal defects in a series of six pediatric patients.

Reconstruction of extensive palatal defects in growing patients aims to restore speech intelligibility and swallowing function while avoiding excessive scarring formation that may cause growth disturbances in the palate and midface region. Free flaps transfer healthy, well-vascularized tissue to the defect area, and their combination with pharyngeal flaps allow for restoration of the velopharyngeal function. We examined speech and swallowing after microsurgical palate reconstruction in a series of six pediatric patients. Radial forearm free flaps were used in all cases, in combination with a superiorly based pharyngeal flap in five cases. Mean age at surgery was 10.7 years. Etiologies included recurrent oronasal fistula due to failed primary cleft palate repair (n=4), embryonal rhabdomyosarcoma of the maxilla (n=1), and inflammatory fibrous hyperplasia (n=1). Speech evaluations (with the Hirose standard and listener ratings) and swallowing assessments (based on videofluoroscopy swallowing studies and patient-reported swallowing and diet) were performed in average 44 months postoperatively. All flaps survived without major postoperative complications. Speech intelligibility was graded as "excellent" in four patients and "moderate" in two. Hypernasality and nasal obstruction were each judged as "none/minimal" in five cases and "moderate" in one case. All patients tolerated oral diet without significant nasal regurgitation. In five of six patients, the swallowing assessment showed good motion and velopharyngeal closure. Microsurgical reconstruction of extensive palatal defects using radial forearm free flap, with or without a superiorly based pharyngeal flap, is a reliable technique that can deliver substantial improvement of speech and swallowing in pediatric patients.

CO2 laser resurfacing for burn and traumatic scars of the hand and upper extremity.

BackgroundScar formation is a normal part of the proliferative phase in wound healing where collagen is remodelled to better approximate normal skin. When collagen is not effectively redistributed, excessive scarring may occur. Recently, CO2 laser has emerged as an adjunct in improving scar quality via remodelling and redistribution of dermal collagen fibres. Due to the paucity of literature related to its use in the hands and upper extremities, we created a study to examine its effects on hypertrophic scars focused on the hands and upper extremities.MethodsPatients treated with CO2 laser for hypertrophic scars of the hand and upper extremity were included. The Vancouver Scar Scale (VSS) and Patient and Observer Scar Assessment Scale (POSAS) were used to assess the progression of scar quality. Unpaired t-tests were performed to determine statistical difference between pre- and post-treatment scores on each scale. Pearson correlation coefficients were used to understand the relationship between number of treatments and scar quality.ResultsOf the 90 patients enrolled, 54 patients completed serial scar assessment forms. All patient and observer-reported POSAS domains showed improvement (P < 0.05) apart from Itching. All VSS domains showed improvement (P < 0.05). There was moderate correlation between overall patient-reported opinion of scar quality and Discoloration, Stiffness and Thickness, and strong correlation between overall patient opinion and Irregularity (r = 0.715). All observer-reported domains were strongly correlated (r = 7.56–8.74) with overall observer opinion of scar quality.ConclusionThe results of this study may further substantiate CO2 laser as a treatment modality for excessive scarring in a variety of surgical subspecialties.Lay SummaryComplex trauma and burns that impact the skin sometimes result in abnormal healing of the skin called, “hypertrophic scarring”. In our study we assessed how using focused CO2 laser therapy impacts patients and health care provider assessment of wound progression. Our results were based upon patient reported and healthcare provider observations based upon two standardized forms the Vancouver Scar Scale (VSS) and the Patient and Observer Scar Assessment Scale (POSAS). What we found is that after CO2 Laser Therapy, our 64 patients with 77 treated scars received on average almost 3 treatments and these treatments helped them with physical function and improved aesthetic appearance of their scars. The health care providers also found that the treatments improved functional and aesthetic end points. Overall, our study helps substantiate the body of evidence that using CO2 laser therapy improves aesthetics and function of hypertrophic scars in the upper extremity.

In Vivo Performance of Microstructured Bacterial Cellulose-Silk Sericin Wound Dressing: Effects on Fibrosis and Scar Formation

Improved healing rates are obtained upon the application of the composite dressings as compared to pure BC. mBC-SS2 prevents the excessive wound contraction which leads to hypertrophied neo-tissue formation when rBC-SS2 is used. The collagen fibers are aligned along the width of microgroove of mBC and its composites while anarchic deposited in the presence of rBC and its composites. Relatively to rBC-SS2, mBC-SS2 constitutes an improved dressing with abilities of inducing rapid wound healing and reducing the risk of excessive fibrosis and scar formation.

A cell membrane repair protein-based nanoformulation with multiple actuators for scarless wound healing.

Diabetic wounds remain a major contributor to disability worldwide due to their difficulty of healing, and their primary etiologic factor involves impaired cell membrane repair. Additionally, ideal wound repair should prevent excessive scar formation from affecting tissue function following reconstruction. Therefore, the development of a therapeutic strategy for promoting rapid wound healing and reduced scar formation is urgently needed. In this study, a remote light-controlled thermosensitive nanoformulation was developed, which integrated the photothermal conversion performance of a photosensitizer and cell membrane repair protein (rhMG53). The nanoformulation not only protected rhMG53 from being degraded by proteases at the lesion site but also efficiently released this protein through photothermal stimulation. The nanoformulation remained stable at physiological temperatures and released approximately 80% rhMG53 at 45 °C. More protein was effectively delivered to tissue cells, achieving synergistic therapy with photothermal and rhMG53. By utilizing this approach, increased wound closure rate, reduced extent of cell membrane damage and inflammation, and improved cell function were observed in diabetic wounds. More importantly, rhMG53@TSCL3 treatment inhibited excessive skin fibrosis and angiogenesis, indicating a reduction in scar formation. Collectively, this work reveals a promising strategy for high-quality wound repair and provides a new route for rapid scarless wound healing.